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South Dakota rates for HCPCS L1080

Addition to cervical-thoracic-lumbar-sacral orthosis (CTLSO) or scoliosis orthosis, outrigger

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.80 / $43.80 / $43.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.15 / $43.80 / $54.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.77 / $40.77 / $68.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.13 / $73.86 / $91.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.70 / $81.38 / $327.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.24 / $47.60 / $80.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.02 / $68.56 / $119.66
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.10 / $69.55 / $143.63
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.83 / $78.22 / $92.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.35 / $36.29 / $66.61
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.09 / $61.09 / $61.09